Examining The Health of Williams County

2019
Examining the health of Williams County
Williams County
Community Health
Needs Assessment
Approved on 09.18.19

FOREWORD | 1

Foreword
It is our pleasure, on behalf of the Williams County Partners for Health Committee, to present the 2019 Williams
County Community Health Assessment. The data contained in this report is a scientifically valid sampling conducted
every three years in the community to better identify and understand health issues facing Williams County
residents. Through a combined effort by the Williams County Health Department, Community Hospitals and
Wellness Centers – Bryan and Montpelier, and the many organizations listed in this publication, we are able to
provide valuable information both to individual residents and organizations in the community. In the past, this
information has helped to educate citizens about their community, and we hope you find the new report helpful in
that regard. Organizations within the community have been able to leverage grant dollars from this report to bring
funds back to Williams County to addresses needs found in these reports.
In the 2019 report, you will find that in many ways the health of our community is very good and ranks higher than
both the nation and state averages. In other areas, you will find we still have challenges that need to be addressed
for the betterment of our community.
Whether you use this information to apply for grants or just become more informed, we hope that you find this
report useful for your purposes. For additional information or questions regarding the report, please contact Jim
Watkins, Williams County Health Commissioner, at 419-485-3141 extension 122.
Sincerely,
James D. Watkins, MPH, RS Chad Tinkel
Health Commissioner CEO
Williams County Health Department Community Hospitals and Wellness Center

ACKNOWLEDGEMENTS | 2

Acknowledgements
This report has been funded by:
Community Hospitals and Wellness Centers—Bryan
Community Hospitals and Wellness Centers—Montpelier
This report has been commissioned by the Williams County Partners for Health:
Amy Boehm, American Cancer Society
Angelia Foster, Community Hospitals and Wellness Centers
Becky McGuire, OSU Extension
Chad Tinkel, Community Hospitals and Wellness Centers
Darrell Higbie, Montpelier Police Department
Diana Savage, Bryan City Schools
James D. Watkins, Williams County Health Department
Jan David, Community Hospitals and Wellness Centers
Jerry Stollings, Juvenile Court
Jim Wyse, Millcreek-West Unity Schools
Maggie Fisher, Williams County Department of Aging
Megan Puehler, Williams County Economic Development
Megan Riley, Williams County Health Department
Rachel Aeschliman, Williams County Health Department
Rob Imber, YMCA
Tonie Long, Four County ADAMhs Board
Wade Patrick, Community Hospitals and Wellness Centers
William D. Hanak, North Central Local Schools
Contact Information
James D. Watkins, MPH, RS
Health Commissioner
Williams County Health Department
419-485-3141
jim.watkins@williamscountyhealth.org
Chad Tinkel
CEO
Community Hospitals and Wellness Centers
419-636-1131

ACKNOWLEDGEMENTS | 3

Project Management, Secondary Data, Data Collection, and Report Development
The Hospital Council of Northwest Ohio (HCNO) is a 501(c)(3) non-profit regional hospital association located in
Toledo, Ohio. They facilitate community health needs assessments and planning processes in 40+ counties in Ohio,
Michigan, and Oregon. Since 2004, they have used a process that can be replicated in any county that allows for
comparisons from county to county, within the region, the state, and the nation. HCNO works with coalitions in
each county to ensure a collaborative approach to community health improvement that includes multiple key
stakeholders, such as those listed above. All HCNO project staff have their master’s degree in public health, with
emphasis on epidemiology and health education.
Britney L. Ward, MPH
Director of Community Health Improvement
Margaret Wielinski, MPH
Assistant Director of Community Health Improvement
Tessa Elliott, MPH, CHES
Community Health Improvement Coordinator
Emily A. Golias, MPH, CHES
Emily Stearns, MPH, CHES
Bailey Fitzgerald
Undergraduate Assistant
Natalie Deeb
Graduate Assistant
Carolynn McCartney
Graduate Assistant
Emily Soles
Graduate Assistant
Data Collection & Analysis
Joseph A. Dake, Ph.D., MPH
Professor and Chair
School of Population Health
University of Toledo
Aaron J Diehr, PhD, CHES
Consultant
Samantha Schroeder, MPA
Consultant
To see Williams County data compared to other counties, please visit the Hospital Council
of Northwest Ohio’s Data Link website at:
http://www.hcno.org/community-services/data-link/
The 2019 Williams County Community Health Assessment is available on the following
websites:
Hospital Council of Northwest Ohio
http://www.hcno.org/community-services/community-health-assessments/
Community Hospitals and Wellness Centers: https://www.chwchospital.org/community-health-assessment/
Williams County Health Department
http://www.williamscountyhealth.org/administration/community-health-assessment/

TABLE OF CONTENTS | 4
Table of Contents
Executive Summary Pages 6-11
Hospital Internal Revenue Services (IRS) Requirements Pages 6-7
Mobilizing for Action through Planning & Partnerships (MAPP) Process Overview Pages 8-9
Primary Data Collection Methods Pages 9-11
2016 Ohio State Health Assessment (SHA) Page 11
Adult Trend Summary Pages 12-14
Adult Data Summary Pages 15-21
HEALTH CARE ACCESS
Adult Health Care Coverage Pages 22-24
Adult Access and Utilization Pages 25-26
Adult Preventive Medicine Pages 27-28
Adult Women’s Health Pages 29-30
Adult Men’s Health Page 31
Adult Oral Health Pages 32-33
HEALTH BEHAVIORS
Adult Health Status Perceptions Pages 34-35
Adult Weight Status Pages 36-39
Adult Tobacco Use Pages 40-41
Adult Alcohol Consumption Pages 42-44
Adult Drug Use Pages 45-53
Adult Sexual Behavior Pages 54-60
Adult Mental Health Pages 61-63
CHRONIC DISEASE
Adult Cardiovascular Health Pages 64-68
Adult Cancer Pages 69-75
Adult Asthma Page 76
Adult Diabetes Pages 77-78
Adult Quality of Life Pages 79-80
SOCIAL CONDITIONS
Adult Social Determinants of Health Pages 81-87
Adult Environmental Conditions Page 88
Adult Parenting Page 89
YOUTH HEALTH
Youth Trend Summary Pages 90-91
Youth Data Summary Pages 92-94
Youth Weight Status Pages 95-97
Youth Tobacco Use Pages 98-101
Youth Alcohol Consumption Pages 102-104
Youth Drug Use Pages 105-107
Youth Sexual Behavior Pages 108-110
Youth Mental Health Pages 111-114
Youth Community Context Pages 115-117
Youth Violence Pages 118-119
Youth Perceptions Pages 120-125

TABLE OF CONTENTS | 5
APPENDICES
APPENDIX I — Health Assessment Information Sources Pages 126-128
APPENDIX II — Acronyms and Terms Page 129
APPENDIX III — Weighting Methods Pages 130-131
APPENDIX IV — School Participation Page 132
APPENDIX V — Demographic Profile Page 133
APPENDIX VI — Demographics and Household Information Pages 134-140
APPENDIX VII — County Health Rankings Pages 141-143

EXECUTIVE SUMMARY | 6
Executive Summary
This executive summary provides an overview of health-related data for Williams County adults (19 years of age
and older) and youth (ages 12 through 18) who participated in a county-wide health assessment survey from
January through May 2019. The findings are based on self-administered surveys using a structured questionnaire.
The questions were modeled after the survey instruments used by the Centers for Disease Control and Prevention
for their national and state Behavioral Risk Factor Surveillance System (BRFSS) and Youth Risk Behavior Surveillance
System (YRBSS). The Hospital Council of Northwest Ohio (HCNO) collected the data, guided the health assessment
process and integrated sources of primary and secondary data into the final report.
In 2019, CHWC—Bryan Hospital and CHWC—Montpelier Hospital (“the hospitals”) worked to align their community
health needs assessment (CHNA) process both at the local and state levels. The state of Ohio mandated by law
(ORC 3701.981) that all hospitals must collaborate with their local health departments on community health
assessments (CHA) and community health improvement plans (CHIP). In order to meet this requirement, the
hospitals shifted their definition of community to encompass the entire county. This will result in less duplication. In
addition, local hospitals have to align with the Ohio State Health Assessment (SHA). This requires alignment of the
CHA process timeline and indicators. This local alignment must take place by October 2020. This report represents
the continued collaboration between the hospitals and Williams County Partners for Health.
Internal Revenue Services (IRS) Requirements
The Affordable Care Act (ACA), enacted in March 2010, added new Section 501 (r) requirements in Part V, Section B,
on 501 (c)(3) organizations that operate one or more hospital facilities. Each 501 (c)(3) hospital organization must
conduct a community health needs assessment and adopt an implementation strategy at least once every three
years. This report meets these IRS requirements.
DEFINITION OF COMMUNITY & SERVICE AREA DETERMINATION
The community has been defined as Williams County. Most (80%) of CHWC—Bryan Hospital and 84% of CHWC—
Montpelier Hospital’s discharges were residents of Williams County. In addition, CHWC collaborates with multiple
stakeholders, most of which provide services at the county-level. For these two reasons, the county was defined as
the community.
INCLUSION OF VULNERABLE POPULATIONS
Williams County is a rural county. Approximately 13.5% of Williams County residents were below the poverty line,
according to the 2013-2017 American Community Survey 5-year estimates. For this reason, data is broken down by
income (less than $25,000 and greater than $25,000) throughout the report to show disparities.
PROCESS & METHODS FOR ENGAGING COMMUNITY
This community health needs assessment process was commissioned by the Williams County Partners for Health.
This coalition has been in existence for 15 years and has approximately 26 member organizations. Multiple sectors,
including the general public, were asked through email list servs, social media, and public notices to participate in
the process which included defining the scope of the project, choosing questions for the surveys, reviewing initial
data, planning a community release, and identifying and prioritizing needs. Thirteen organizations worked together
to create one comprehensive assessment and plan.
QUANTITATIVE & QUALITATIVE DATA ANALYSIS
The Hospital Council of Northwest Ohio was contracted to collect the data, analyze it, and provide overall project
management. Detailed data collection methods are described later in this section.

IDENTIFYING & PRIORITIZING NEEDS
The identification and prioritization of health needs will take place during the community health improvement
planning process. The hospitals will collaborate with the Williams County Partners for Health to create the 2020-
2022 Williams County Community Health Improvement Plan (CHIP) in which the identification and prioritization of
health needs will take place.
RESOURCES TO ADDRESS NEED
The identification of resources will take place during the community health improvement planning process. The
hospitals will collaborate with the Williams County Partners for Health to create the 2020-2022 Williams County
Community Health Improvement Plan (CHIP) in which a resource assessment will take place.
CHNA AVAILABILITY
The 2019 Community Health Needs Assessment, as well as the various other assessments used in creating this
report, can be found at the following websites:
Community Hospitals and Wellness Centers: https://www.chwchospital.org/community-health-assessment/
Williams County Health Department:
http://www.williamscountyhealth.org/administration/community-health-assessment/
Hospital Council of Northwest Ohio: http://www.hcno.org/community-services/community-health-assessments/
ADOPTION BY BOARD
The Board adopted the 2019 Community Health Needs Assessment on September 18, 2019.

Mobilizing for Action through Planning & Partnerships (MAPP) Process Overview
National Public Health Accreditation status through the Public Health Accreditation Board (PHAB) requires
Community Health Assessments (CHAs) to be completed at least every five years. The purpose of the community
health assessment is to learn about the health of our community, including health issues and disparities,
contributing factors that impact health outcomes, and community assets and resources that can be mobilized to
improve population health.
This 2019 CHA was developed using the Mobilizing Action through Partnerships and Planning (MAPP) process,
which is a nationally adopted framework developed by the National Association of County and City Health Officials
(NACCHO) (see Figure 1.1). MAPP is a community-driven planning process for improving community health and is
flexible in its implementation, meaning that the process does not need to be completed in a specific order. This
process was facilitated by HCNO in collaboration with a broad range of local agencies representing a variety of
sectors of the community. This process involved the following six phases:
1. Organizing for success and partnership development
During this first phase, community partners examined the structure
of its planning process to build commitment and engage partners in
the development of a plan that could be realistically implemented.
With a steering committee already in place, members examined
current membership to determine whether additional stakeholders
and/or partners should be engaged, its meeting schedule (which
occurs on a quarterly basis and more frequently as needed), and
responsibilities of partnering organizations for driving change. The
steering committee ensured that the process involved local public
health, health care, faith-based communities, schools, local
leadership, businesses, organizations serving minority populations,
and other stakeholders in the community health improvement
process.
2. Visioning
Next, steering committee members re-examined its vision and
mission. Vision and values statements provide focus, purpose, and
direction to the CHA/CHIP so that participants collectively achieve a
shared vision for the future. A shared community vision provides an overarching goal for the community—a
statement of what the ideal future looks like. Values are the fundamental principles and beliefs that guide a
community-driven planning process.
3. The four assessments
While each assessment yields valuable information, the value of the four MAPP assessments is multiplied
considering results as a whole. The four assessments include: The Community Health Status Assessment (CHSA),
the Local Public Health System Assessment (LPHSA), the Forces of Change (FOC) Assessment, and the Community
Themes and Strengths Assessment (CTSA).
4. Identifying strategic issues
The process to formulate strategic issues occurs during the prioritization process of the CHA/CHIP. The committee
considers the results of the assessments, including data collected from community members (primary data) and
existing statistics (secondary data) to identify key health issues. Upon identifying the key health issues, an objective
ranking process is used to prioritize health needs for the CHIP.
In order to identify strategic issues, the steering committee considers findings from the visioning process and the
MAPP assessments in order to understand why certain issues remain constant across the assessments. The steering
committee uses a strategic approach to prioritize issues that would have the greatest overall impact to drive
population health improvement and would be feasible, given the resources available in the community and/or
needed, to accomplish. The steering committee also arranged issues that were related to one another, for example,
chronic disease related conditions, which could be addressed through increased or improved coordination of
preventative services. Finally, the steering committee members considered the urgency of issues and the
consequences of not addressing certain items.
Figure 1.1 The MAPP Framework

5. Formulate goals and strategies
Following the prioritization process, a gap analysis is completed in which committee members identify gaps within
each priority area, identify existing resources and assets, and potential strategies to address the priority health
needs. Following this analysis, the committee to formulate various goals, objectives, and strategies to meet the
prioritized health needs.
6. Action cycle
The steering committee begins implementation of strategies as part of the next community health improvement
cycle. Both progress data to track actions taken as part of the CHIP’s implementation and health outcome data (key
population health statistics from the CHA) are continually tracked through ongoing meetings. At the end of the
CHIP cycle, partners review progress to select new and/or updated strategic priorities based on progress and the
latest health statistics.
Primary Data Collection Methods
DESIGN
This community health assessment was cross-sectional in nature and included a written survey of adults, and
adolescents within Williams County. From the beginning, community leaders were actively engaged in the planning
process and helped define the content, scope, and sequence of the study. Active engagement of community
members throughout the planning process is regarded as an important step in completing a valid needs
assessment.
INSTRUMENT DEVELOPMENT
Two survey instruments were designed and pilot tested for this study: one for adults and one for adolescents in
grades 6-12. As a first step in the design process, health education researchers from the University of Toledo and
staff members from the Hospital Council of Northwest Ohio met to discuss potential sources of valid and reliable
survey items that would be appropriate for assessing the health status and health needs of adults and adolescents.
The investigators decided to derive most the adult survey items from the BRFSS and many of adolescent survey
items from the YRBSS. This decision was based on being able to compare local data with state and national data.
The project coordinator from the Hospital Council of Northwest Ohio conducted a series of meetings with the
planning committee from Williams County. During these meetings, HCNO and the planning committee reviewed
and discussed banks of potential survey questions. Based on input from the Williams County planning committee,
the project coordinator composed drafts of surveys containing 115 items for the adult survey and 77 items for the
adolescent survey. Health education researchers from the University of Toledo reviewed and approved the drafts.
SAMPLING | Adult Survey
The sampling frame for the adult survey consisted of adults ages 19 and over living in Williams County. There were
28,142 persons ages 19 and over living in Williams County. The investigators conducted a power analysis to
determine what sample size was needed to ensure a 95% confidence level with a corresponding margin of error of
5% (i.e., we can be 95% sure that the “true” population responses are within a 5% margin of error of the survey
findings). A sample size of at least 379 adults was needed to ensure this level of confidence. The random sample of
mailing addresses was obtained from Melissa Data Corporation in Rancho Santa Margarita, California.
SAMPLING | Adolescent Survey
Youth in grades 6-12 in Williams County public school districts were used as the sampling frame for the adolescent
survey. Using the U.S. Census Bureau data, it was determined that approximately 3,622 youth ages 12 to 18 years
old live in Williams County. A sample size of 347 adolescents was needed to ensure a 95% confidence interval with
a corresponding 5% margin of error. Students were randomly selected and surveyed in the schools.

PROCEDURE | Adult Survey
Data collection for this assessment was completed with a multimodal approach: a random sample via mail, a
random sample via e-mail (online), and an online convenience sample. This multimodal approach was a pilot to
increase survey response rates across the county.
Prior to mailing the survey, the project team mailed an advance letter to 1,200 adults in Williams County. This
advance letter was personalized, printed on Williams County Partners for Health letterhead, and signed by James D.
Watkins, Health Commissioner of the Williams County Health Department. The letter introduced the county health
assessment project and informed the readers that they may be randomly selected to receive the survey. The letter
also explained that the respondents’ confidentiality would be protected and encouraged the readers to complete
and return the survey promptly if they were selected. Three weeks following the advance letter, a three-wave
mailing procedure was implemented to maximize the survey return rate. The initial mailing included a personalized
hand signed cover letter (on Williams County Partners for Health letterhead) describing the purpose of the study, a
questionnaire, a self-addressed stamped return envelope, and a $2 incentive. Approximately three weeks after the
first mailing, a second wave mailing included another personalized cover letter encouraging them to reply, another
copy of the questionnaire, and another reply envelope. A third wave postcard was sent three weeks after the second
wave mailing. Surveys returned as undeliverable were not replaced with another potential respondent.
The online survey yielded 89 completed surveys: 25 from the random sample and 64 from the convenience sample.
Methods were compared across the primary mailed survey, the online random sampling, and the online through
convenience sampling. Upon review, it was determined that there were very little differences between the survey
samples. Therefore, the samples were combined and analyzed as one dataset.
The response rate for the mailing was 36% (n=413: CI=± 4.79). This return rate and sample size means that the
responses in the health assessment should be representative of the entire county.
PROCEDURE | Adolescent Survey
The survey was approved by all participating superintendents. Schools and grades were randomly selected. To
ensure that students in a particular grade had an equal chance of being selected, the research team used “general”
school classes like English or Health to distribute surveys. Classrooms were chosen by the school principal. Passive
permission slips were mailed home to parents of any student whose class was selected to participate. The response
rate was 94% (n=404: CI=± 4.60).
DATA ANALYSIS
Individual responses were anonymous. Only group data was available. All data was analyzed by health education
researchers at the University of Toledo using SPSS 24.0. Crosstabs were used to calculate descriptive statistics for
the data presented in this report. To be representative of Williams County, the adult data collected was weighted by
age, gender, race, and income using 2016 Census data. Multiple weightings were created based on this information
to account for different types of analyses. For more information on how the weightings were created and applied,
see Appendix III.
LIMITATIONS
As with all county health assessments, it is important to consider the findings with respect to all possible
limitations. For example, if any important differences existed between the respondents and the non-respondents
regarding the questions asked, this would represent a threat to the external validity of the results (the
generalizability of the results to the population of Williams County). If there were little to no differences between
respondents and non-respondents, then this would not be a limitation.
Furthermore, while the survey was mailed to random households in Williams County, those responding to the
survey were more likely to be older. For example, only 12 respondents were under the age of 30. While weightings
are applied during calculations to help account for this, it still presents a potential limitation (to the extent that the
responses from these 12 individuals are substantively different from the majority of Williams County residents
under the age of 30).

Finally, it is important to note that, although several questions were asked using the same wording as the CDC
questionnaires, the adult data collection method differed. CDC adult data was collected using a set of questions
from the total question bank, and adults were asked the questions over the telephone rather than via mail survey.
The youth CDC survey was administered in schools in a similar fashion as this county health assessment. Caution
should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of
the overall survey.
2019 Ohio State Health Assessment (SHA)
The 2019 Ohio State Health Assessment (SHA) provides data needed to inform health improvement priorities and
strategies in the state. This assessment includes over 140 metrics, organized into data profiles, as well as
information gathered through five regional forums, online surveys completed by over 300 stakeholders, and
advisory and steering committee members who represented 13 state agencies, including sectors beyond health.
Similar to the 2019 Ohio SHA, the 2019 Williams County Community Health Assessment (CHA) examined a variety
of metrics from various areas of health including, but not limited to, health behaviors, chronic disease, access to
health care, and social determinants of health. Additionally, the CHA studied themes and perceptions from local
public health stakeholders from a wide variety of sectors. Note: This symbol will be displayed in the trend
summary when an indicator directly aligns with the 2019 Ohio SHA.
The interconnectedness of Ohio’s greatest health challenges, along with the overall consistency of health priorities
identified in this assessment, indicates many opportunities for collaboration between a wide variety of partners at
and between the state and local level, including physical and behavioral health organizations and sectors beyond
health. It is our hope that this CHA will serve as a foundation for such collaboration.
To view the 2019 Ohio State Health Assessment, please visit: https://odh.ohio.gov/wps/portal/gov/odh/explore-
data-and-stats/interactive-applications/2019-Online-State-Health-Assessment
FIGURE 1.1 | Components of the 2019 SHA

2019
ADULT
(AGES 19+)
DATA

ADULT TREND SUMMARY | 13
Adult Trend Summary
N/A – Not Available
Indicates alignment with the Ohio State Health Assessment
*2016 BRFSS
**2016 BRFSS as compiled by 2019 County Health Rankings
Adult Variables
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Health Status
Rated general health as excellent or very good 56% 55% 47% 49% 51%
Rated general health as fair or poor 10% 14% 13% 19% 18%
Rated mental health as not good on four or more days (in the
past 30 days)
15% 23% 30% 26% 24%
Rated physical health as not good on four or more days (in the
past 30 days)
18% 20% 20% 23% 22%
Average number of days that physical health was not good (in
the past 30 days)
2.6 3.5 3.5 4.0* 3.7*
Average number of days that mental health was not good (in
the past 30 days)
2.3 4.5 4.4 4.3* 3.8*
Poor physical or mental health kept them from doing usual
activities, such as self-care, work, or recreation (on at least one
day during the past 30 days)
18% 17% 29% 24% 23%
Health Care Coverage, Access, and Utilization
Uninsured 15% 5% 7% 9% 11%
Had one or more persons they thought of as their personal
health care provider
51% 51% 86% 81% 77%
Visited a doctor for a routine checkup (in the past 12 months) 50% 59% 64% 72% 70%
Arthritis, Asthma, & Diabetes
Ever been told by a doctor they have diabetes (not pregnancy-
related)
8% 7% 12% 11% 11%
Had ever been told they have asthma 12% 18% 13% 14% 14%
Cardiovascular Health
Ever diagnosed with angina or coronary heart disease 6% 6% 7% 5% 4%
Ever diagnosed with a heart attack, or myocardial infarction 5% 4% 6% 6% 4%
Ever diagnosed with a stroke 3% 1% 4% 4% 3%
Had been told they had high blood pressure 29% 35% 39% 35% 32%
Had been told their blood cholesterol was high 35% 36% 37% 33% 33%
Had their blood cholesterol checked within the last five years 70% 79% 83% 85% 86%
Weight Status
Overweight 38% 30% 31% 34% 35%
Obese 30% 41% 42% 34% 32%
Alcohol Consumption
Current drinker (had at least one drink of alcohol within the past
30 days)
45% 39% 62% 54% 55%
Binge drinker (males having five or more drinks on one occasion,
females having four or more drinks on one occasion)
18% 15% 17% 19% 17%
Tobacco Use
Current cigarette smoker (smoked on some or all days) 20% 22% 16% 21% 17%
Former cigarette smoker (smoked 100 cigarettes in lifetime and
now do not smoke)
24% 18% 25% 24% 25%
Current e-cigarette user (vaped on some or all days) N/A N/A 5% 5% 5%

ADULT TREND SUMMARY | 14
*2016 BRFSS
**2015 BRFSS
Adult Variables
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Drug Use
Adults who used marijuana in the past 6 months 3% 4% 3% N/A N/A
Adults who misused prescription drugs in the past 6 months 6% 5% 5% N/A N/A
Preventive Medicine
Ever had a pneumonia vaccine (ages 65 and older) 56% 67% 77% 76% 75%
Had a flu shot within the past year (ages 65 and over) 72% 72% 76% 63% 60%
Had a clinical breast exam in the past two years
(women ages 40 and older)
68% 66% 52% N/A N/A
Had a mammogram within the past two years
(women ages 40 and older)
69% 67% 65% 74%* 72%*
Had a pap test in the past three years (women ages 21-65) 66% 54% 59% 82%* 80%*
Cancer
Ever been told they had skin cancer 5% 6% 7% 6% 6%
Ever been told they had other types of cancer (other than skin
cancer)
7% 9% 9% 7% 7%
Quality of Life
Limited in some way because of physical, mental or emotional
problem
20% 15% 22% 21%* 21%*
Mental Health
Felt sad or hopeless for two or more weeks in the past year 8% 9% 13% N/A N/A
Seriously considered attempting suicide in the past year 3% 2% 5% N/A N/A
Attempted suicide in the past year <1% 0% 1% N/A N/A
Sexual Behavior
Had more than one sexual partner in past year 3% 4% 3% N/A N/A
Oral Health
Visited a dentist or a dental clinic (within the past year) 65% 53% 73% 68%* 66%*
Visited a dentist or a dental clinic (5 or more years ago) 10% 15% 11% 11%* 10%*

ADULT DATA SUMMARY | 15
Adult Data Summary
Adult Data Summary | Health Care Access
ADULT HEALTH CARE COVERAGE
One-in-fourteen (7%) Williams County adults were without healthcare coverage.
ADULT ACCESS AND UTILIZATION
Nearly two-thirds (64%) of Williams County adults visited a doctor for a routine checkup in the past year. Three-
fifths (60%) of adults went outside of Williams County for healthcare services in the past year.

7% 7%
8%
17%
8%
2%
7%
8%
0%
10%
20%
Williams
County 2019
Male Female 19-29 Years 30-64 Years 65 Years &
Older
Income
<$25K
Income $25K
Plus
Uninsured Williams County Adults
64% 64% 63%
67%
61%
80%
70%
59%
0%
20%
40%
60%
80%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adults who Visited a Doctor
for a Routine Checkup in the Past Year

ADULT PREVENTIVE MEDICINE
More than half (56%) of Williams County adults had a flu vaccine during the past 12 months. More than three-
fourths (77%) of adults ages 65 and older had a pneumonia vaccination at some time in their life.
ADULT WOMEN’S HEALTH
More than half (51%) of women ages 40 and older had a mammogram in the past year. Nearly three-fifths (59%) of
women ages 21-65 had a Pap smear in the past three years. Forty-seven percent (47%) of women were obese, 34%
had high blood pressure, 32% had high blood cholesterol, and 19% were identified as smokers, all known risk
factors for cardiovascular diseases.
ADULT MEN’S HEALTH
Nearly half (45%) of men had high blood cholesterol, 45% had been diagnosed with high blood pressure, and 11%
were identified as smokers, which, along with obesity (38%), are known risk factors for cardiovascular diseases.
ADULT ORAL HEALTH
Nearly three-fourths (73%) of Williams County adults visited a dentist or dental clinic in the past year. Twenty-six
percent (26%) of adults who did not see a dentist in the past year were unable to do so due to cost.
56% 53%
58%
42%
51%
76% 77%
51%
0%
20%
40%
60%
80%
Williams
County 2019
Males Females 19-29 Years 30-64 Years 65 Years &
Older
Income
<$25K
Income $25K
Plus
Williams County Adults who Recieved a Flu Shot Within the Past Year
73%
69%
75%
54%
76%
71%
53%
77%
0%
20%
40%
60%
80%
Williams
County 2019
Older
Income
<$25K
Income
$25K Plus
Williams County Adults Visiting a Dentist in the Past Year

Adult Data Summary | Health Behaviors
ADULT HEALTH STATUS PERCEPTIONS
Nearly half (47%) of Williams County adults rated their health status as excellent or very good. Conversely, about
one-in-eight (13%) adults described their health as fair or poor, increasing to 28% of those with incomes less than
$25,000.

*Respondents were asked: “Would you say that in general your health is excellent, very good, good, fair or poor?
ADULT WEIGHT STATUS
Almost three-quarters (73%) of Williams County adults were either overweight (31%), obese (20%), severely obese
(14%), or morbidly obese (8%) by Body Mass Index (BMI). More than half (57%) of adults engaged in some type of
physical activity or exercise for at least 30 minutes on 3 or more days per week.
47% 50% 45%
33%
54%
37%
21%
55%
40% 37% 43% 67%
34%
42%
51%
35%
13% 13% 12%
0%
12%
21%
28%
10%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adult Health Perceptions*
Excellent/Very Good Good Fair/Poor
26% 22%
29%
8%
26% 21% 19%
27%
31% 40% 23%
31%
27% 41%
29%
35%
42% 38%
47%
61%
46%
36%
50%
37%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income <
$25K
Income $25K
Plus
Williams County Adult BMI Classifications*
Obese, including Severely and Morbildy Obese (BMI of 30.0 and above)
Overweight (BMI of 25.0-29.9)
Normal (BMI of 18.5-24.9)

ADULT TOBACCO USE
In 2019, 16% of Williams County adults were current cigarette smokers and 25% were considered former cigarette
smokers.
ADULT ALCOHOL USE
More than three-fifths (62%) of Williams County adults had at least one alcoholic drink in the past month and are
considered current drinkers. One-third (33%) of those current drinkers were binge drinkers [had five or more
alcoholic drinks (for males) or 4 or more drinks (for females) on an occasion in the last month].
16% 11%
19% 25%
17%
9%
30%
13%
25% 35% 18%
8%
24% 40%
28%
28%
59% 54%
63% 67%
59%
51%
42%
59%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adult Cigarette Smoking Behaviors
Current smoker Former smoker Never smoked
38% 35% 41%
54%
32%
49% 46%
35%
22%
16%
26%
8%
22%
26% 29%
20%
40%
49%
33% 38%
46%
25% 24%
45%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Average Number of Days Drinking Alcohol in the Past Month
Did not drink any 1-2 days 3 or more days

ADULT DRUG USE
Three percent (3%) of Williams County adults had used recreational marijuana during the past 6 months. Five
percent (5%) of adults had used medication not prescribed for them or took more than prescribed to feel good or
high and/or more active or alert during the past 6 months.
ADULT SEXUAL BEHAVIOR
In 2019, 65% of Williams County adults had sexual intercourse in the past year. Three percent (3%) of adults had
more than one partner. Ten percent (10%) of Williams County adults reported being forced to participate in sexual
activity when they did not want to.
ADULT MENTAL HEALTH
In the past year, 13% of Williams County adults had a period of two or more weeks when they felt so sad or
hopeless nearly every day that they stopped doing usual activities. Five percent (5%) of Williams County adults
considered attempting suicide, and 1% actually attempted suicide.
5%
2%
7%
10%
5%
3%
0%
5%
0%
5%
10%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adult Prescription Drug Misuse in Past 6 Months
62% 64% 60%
83%
67%
28% 29%
67%
3% 3%
4%
8%
3%
0% 2%
2%
34% 32% 36%
8%
29%
71% 66%
31%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Number of Sexual Partners in the Past Year
One More than one None

Adult Data Summary | Chronic Disease
ADULT CARDIOVASCULAR HEALTH
Six percent (6%) of Williams County adults survived a heart attack and 4% survived a stroke at some time in their
life. Nearly two-fifths (39%) of adults had high blood pressure, 37% had high blood cholesterol, 42% were obese,
and 16% were smokers, all known risk factors for cardiovascular disease.
ADULT CANCER
In 2019, 16% of Williams County adults had been diagnosed with cancer at some time in their life.
ADULT ASTHMA
In 2019, 13% of Williams County adults had been diagnosed with asthma.
ADULT DIABETES
Twelve percent (12%) of Williams County adults had been diagnosed with diabetes.
42%
39%
37%
27%
16%
12%
0%
25%
50%
Obesity High Blood
Pressure
High Blood
Cholesterol
Sedentary Smoking Diabetes
Williams County Adults with CVD Risk Factors
12%
16%
8%
0%
10%
27%
19%
10%
0%
15%
30%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adults Diagnosed with Diabetes (Not Pregnancy-Related)

ADULT QUALITY OF LIFE
In 2019, 22% of Williams County adults were limited in some way because of a physical, mental or emotional
problem.
Adult Data Summary | Social Conditions
ADULT SOCIAL DETERMINANTS OF HEALTH
Six percent (6%) of Williams County adults were abused in the past year. Sixteen percent (16%) of adults
experienced four or more Adverse Childhood Experiences (ACEs). More than half (51%) of Williams County adults
kept a firearm in or around their home.
ADULT ENVIRONMENTAL HEALTH
Adults indicated that insects (12%), mold (7%), temperature regulation (7%) threatened their health in the past year.
ADULT PARENTING
Approximately one in six (16%) parents never breastfed their child. Two-thirds (67%) of parents discussed bullying,
59% discussed weight status, and 58% discussed dating/relationships and social media issues with their 6-to-17 year-
old in the past year.
22%
19%
25%
31%
17%
40%
53%
15%
0%
20%
40%
60%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adults Limited in Some Way
51%
60%
43%
58%
51% 49%
32%
60%
0%
20%
40%
60%
80%
Williams
County 2019
Over
Income
<$25K
Income $25K
Plus
Williams County Adults With a Firearm in the Home

HEALTHCARE COVERAGE | 22

Healthcare Access: Adult Healthcare Coverage
Key Findings
One-in-fourteen (7%) Williams County adults were without healthcare coverage.
Health Coverage
 In 2019, 93% of Williams County adults had healthcare coverage.
 In the past year, 7% of adults were uninsured.
 One-in-ten (10%) adults with children did not have healthcare coverage, compared to 4% of those who did not
have children living in their household.
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Uninsured 15% 5% 7% 9% 11%
The following graph shows the percentage of Williams County adults who were uninsured. An example of
how to interpret the information in the graph includes: 7% of all Williams County adults were uninsured,
including 17% of those ages 19-29.
Note: Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the overall survey.
7% 7%
8%
17%
8%
2%
7%
8%
0%
10%
20%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Uninsured Williams County Adults
In Williams County, 1,970 adults were uninsured.


Healthy People 2020
Access to Health Services (AHS)
Objective
Williams
County
2019
Ohio
2017
U.S.
2016
Healthy People
2020 Target
AHS-1.1: Persons under age of
65 years with health insurance
100% age 18-24
91% age 25-34
90% age 35-44
94% age 45-54
100% age 55-64
87% age 18-24
90% age 25-34
90% age 35-44
91% age 45-54
93% age 55-64
85% age 18-24
84% age 25-34
87% age 35-44
90% age 45-54
93% age 55-64
100%
Note: U.S. baseline is age-adjusted to the 2000 population standard
(Sources: Healthy People 2020 Objectives, 2016 BRFSS, 2017 BRFSS, 2019 Williams County Community Health Assessment)
 The following types of healthcare coverage were used: employer (50%); Medicare (24%); someone else’s
employer (12%); Medicaid or medical assistance (8%); self-purchased plan (3%); Health Insurance Marketplace
(1%); military, CHAMPUS, TriCare, CHAMPVA or the VA (1%); multiple, including private insurance (1%); and
multiple, including government insurance (<1%).
 Adult healthcare coverage included the following:
— Medical (100%)
— Prescription coverage (93%)
— Dental (83%)
— Immunizations (81%)
— Vision or eyeglasses (76%)
— Preventive health (70%)
— Their children (51%)
— Mental health counseling (49%)
— Mental health (45%)
— Outpatient therapy (35%)
— Their spouse (33%)
— County physicians (24%)
— Alcohol and drug treatment (19%)
— Their partner (17%)
— Long-term care (14%)
— Home care (8%)
— Skilled nursing (8%)
— Hospice (5%)
— Transportation (3%)
— Assisted living (3%)
 Adults had the following issues regarding their healthcare coverage:
— Cost (36%)
— Opted out of certain coverage because they
could not afford it (10%)
— Service not deemed medically necessary (8%)
— Limited visits (8%)
— Currently working with their insurance
company (8%)
— Opted out of certain coverage because they
did not need it (7%)
— Could not understand their insurance plan
(7%)
— Service no longer covered (4%)
— Pre-existing conditions (2%)
— Provider was no longer covered (2%)
 The top reasons uninsured adults gave for being without healthcare coverage were*:
1. They lost their job or changed employers (39%)
2. They could not afford the co-pays, premiums, and deductibles (30%)
3. They became ineligible (11%)
*(Percentages do not equal 100% because respondents could select more than one reason)


The following chart identifies sources of healthcare coverage for Williams County adults.
The following table shows what is included in Williams County adults’ health insurance coverage.
Health Coverage Includes: Yes No Don’t Know
Medical 100% 0% 0%
Prescription Coverage 93% 0% 7%
Dental 83% 12% 5%
Immunizations 81% 0% 19%
Vision 76% 19% 5%
Preventive Health 70% 3% 27%
Their Children 51% 40% 9%
Mental Health Counseling 49% 11% 40%
Mental Health 45% 15% 40%
Outpatient Therapy 35% 3% 62%
Their Spouse 33% 44% 22%
County Physicians 24% 3% 73%
Alcohol and Drug Treatment 19% 11% 70%
Their Partner 17% 49% 34%
Long-Term Care 14% 6% 80%
Home Care 8% 16% 76%
Skilled Nursing 8% 12% 80%
Hospice 5% 11% 84%
Assisted Living 3% 16% 81%
Transportation 3% 24% 73%
Employer
50%
Medicare
24%
Medicaid or medical assistance, 8%
Self-purchased plan, 3%
Someone Else's
Employer, 12%
Military, CHAMPUS, TriCare,
CHAMPVA or the VA , 1%
Health Insurance
Marketplace, 1%
Multiple, including private insurance, 1%Multiple, including government insurace, <1%
Source of Healthcare Coverage for Williams County Adults

ACCESS AND UTILIZATION | 25

Healthcare Access: Adult Access and Utilization
Key Findings
Nearly two-thirds (64%) of Williams County adults visited a doctor for a routine checkup in the past year. Three-fifths
(60%) of adults went outside of Williams County for healthcare services in the past year.

Healthcare Access
 Nearly two-thirds (64%) of Williams County adults visited a doctor for a routine checkup in the past year,
increasing to 80% of those ages 65 and older.
 Adults with healthcare coverage were more likely to have visited a doctor for a routine checkup in the past year
(65%), compared to 38% of those without healthcare coverage.
 More than four-fifths (86%) of adults indicated they had at least one person they thought of as their personal
doctor or healthcare provider.
 In the past year, 14% of Williams County adults needed to see a doctor/healthcare professional but could not
because of cost.
The following graph shows the percentage of Williams County adults who had a routine check-up in the past
year. An example of how to interpret the information includes: 64% of all Williams County adults had a
routine check-up in the past year, including 70% of those with incomes less than $25,000 and 80% of those
65 years and older.
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Visited a doctor for a routine checkup (in the past 12
months)
50% 59% 64% 72% 70%
Visited a doctor for a routine checkup (5 or more years
ago)
15% 8% 9% 9% 7%
Had one or more persons they thought of as their
personal health care provider
78% 76% 86% 81% 77%
Unable to see a doctor due to cost (in the past 12 months) N/A N/A 14% 13% 14%
64% 64% 63%
67%
61%
80%
70%
59%
0%
20%
40%
60%
80%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adults who Visited a Doctor
for a Routine Checkup in the Past Year

ACCESS AND UTILIZATION | 26

 Sixty-two percent (62%) of adults reported they received medical care in the past 12 months. Reasons for not
receiving medical care included the following:
— No need to go (23%)
— Cost/no insurance (6%)
— Too long of a wait for an appointment (2%)
— Office wasn’t open when they could get there
(1%)
— Too embarrassed to seek help (1%)
— Distance (1%)
— No childcare (<1%)
— Inconvenient appointment times (1%)
— Provider did not take their insurance (<1%)
— Other problems that prevented them from
getting medical care (4%)
 The following might prevent Williams County adults from seeing a doctor if they were sick, injured, or needed
some kind of health care:
— Cost/no insurance (23%)
— Difficult to get an appointment (14%)
— Inconvenient hours (11%)
— Could not get time off work (11%)
— Worried they might find something
wrong (6%)
— Doctor would not take their insurance (5%)
— Do not trust or believe doctors (4%)
— Frightened of the procedure or doctor (2%)
— Could not find childcare (2%)
— Difficult to find/no transportation (1%)
 Williams County adults have not gotten any of the following recommended major care or preventive care due
to cost:
— Weight loss program (8%)
— Medications (7%)
— Mammogram (6%)
— Colonoscopy (5%)
— Lab testing (5%)
— Surgery (5%)
— Mental health services (5%)
— Pap smear test (4%)
— Smoking cessation (2%)
— PSA test (2%)
— Alcohol and/or drug treatment (1%)
— Family planning services (1%)
— Other care/services (5%)
 Adults usually visited the following places when they were sick or needed advice about their health:
— A doctor’s office (71%)
— Urgent care center (10%)
— Internet (4%)
— Bryan Community Health Center (4%)
— Family and friends (3%)
— VA (1%)
— Chiropractor (1%)
— A hospital emergency room (<1%)
— Health department (<1%)
— Alternative therapies (<1%)
— Telemedicine (<1%)
— Multiple places, including a doctor’s office (<1%)
— Did not have a usual place (3%)
 Three-fifths (60%) of adults visited the following places outside of Williams County for healthcare services in the
past 12 months:
— Specialty care (24%)
— Primary care (18%)
— Dental services (15%)
— Female health services (8%)
— Dermatological care (7%)
— Obstetrics/gynecology (7%)
— Cardiac care (5%)
— Mental healthcare/counseling services (5%)
— Ear, nose, throat care (5%)
— Orthopedic care (4%)
— Pediatric care (3%)
— Cancer care (3%)
— Podiatry care (3%)
— Pediatric therapies (1%)
— Bariatric care (1%)
— Addiction services (1%)
— Skilled nursing rehabilitation (<1%)
— Another service (8%)

PREVENTIVE MEDICINE | 27
Healthcare Access: Adult Preventive Medicine
Key Findings
More than half (56%) of Williams County adults had a flu vaccine during the past 12 months. More than three-
fourths (77%) of adults ages 65 and older had a pneumonia vaccination at some time in their life.
Preventive Medicine
 More than half (56%) of Williams County adults had a flu vaccine during the past 12 months, increasing to 76%
of Williams County adults ages 65 and older
 Adults did not get all their recommended flu vaccination for the following reasons: did not need it (20%), got
sick from it (9%), believed it does not work (8%), vaccine was not effective (7%), time (4%), cost (3%), religious
beliefs (1%), and other (13%).

The following graph shows the percentage of Williams County adults who received a flu shot within the past
year. An example of how to interpret the information shown on the graph includes: 56% of Williams County
adults received a flu shot within the past year, including 58% of females and 77% of those with incomes less
than $25,000.
Healthy People 2020
Immunization and Infectious Diseases (IID)
Note: U.S. baseline is age-adjusted to the 2000 population standard.
(Sources: Healthy People 2020 Objectives, 2017 BRFSS, 2019 Williams County Community Health Assessment)
56% 53%
58%
42%
51%
76% 77%
51%
0%
20%
40%
60%
80%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adults who Recieved a Flu Shot Within the Past Year
Objective
Williams
County
2019
Ohio
2017
U.S.
2017
Healthy
People
2020
Target
IID-12.7: Increase the percentage of non-
institutionalized high-risk adults aged 65
years and older who are vaccinated
annually against seasonal influenza
76% 63% 60% 90%
12,382 Williams County adults did not receive a flu shot in the past year.

PREVENTIVE MEDICINE | 28
 More than one-third (35%) of adults have had a pneumonia vaccination in their life, increasing to 77% of those
ages 65 and over.
 Williams County adults have had the following preventive screenings or exams: colonoscopy in the past 10
years (40%), skin cancer screening in the past year (21%), oral cancer screening in the past year (14%), blood
stool test in the past year (13%), lung cancer in the past 3 years (4%), and sigmoidoscopy in the past 5 years
(3%).

 Nearly two-thirds (64%) of adults over the age of 50 had a colonoscopy in the past 10 years.
 Williams County adults have had the following vaccines:
— Measles, mumps, and rubella (MMR) in their
lifetime (77%)
— Tetanus booster (Td/Tdap) in the past 10
years (73%)
— Chicken pox vaccine in their lifetime (48%)
— Hepatitis B vaccine in their lifetime (47%)
— Hepatitis A vaccine in their lifetime (37%)
— Zoster (shingles) vaccine in their
lifetime (21%)
— Human papillomavirus (HPV) vaccine in their
lifetime (15%)
 In the past 12 months, adults reported their doctor talked to them about the following topics:
— Family history (46%)
— Weight control (35%)
— Depression, anxiety, or emotional
problems (27%)
— Safe use of prescription medication (22%)
— Tobacco use (17%)
— Alternative pain therapy (13%)
— Family planning (13%)
— Alcohol use (11%)
— Injury prevention (10%)
— PSA test (9%)
— Bone density (9%)
— Falls (9%)
— Safe use of opiate-based pain
medications (7%)
— Sexually transmitted diseases (7%)
— Genetic testing (6%)
— Illicit drug abuse (4%)
— Self-testicular exams (4%)
— Domestic violence (4%)
— Firearm safety (3%)
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Had a flu shot within the past year (ages 65
and over)
72% 72% 76% 63% 60%
Ever had a pneumonia vaccine (ages 65 and
older)
56% 67% 77% 76% 75%

WOMEN’S HEALTH | 29

Healthcare Access: Adult Women’s Health
Key Findings
More than half (51%) of women ages 40 and older had a
mammogram in the past year. Nearly three-fifths (59%) of women
ages 21-65 had a Pap smear in the past three years. Forty-seven
percent (47%) of women were obese, 34% had high blood
pressure, 32% had high blood cholesterol, and 19% were
identified as smokers, all known risk factors for cardiovascular
diseases.
Women’s Health Screenings
 A mammogram is an x-ray picture of the breast. Sixty percent
(60%) of women had a mammogram at some time in their life,
and one-third (33%) had this screening in the past year.
 More than half (51%) of women ages 40 and over had a
mammogram in the past year, and 65% had one in the past
two years.
 A clinical breast exam is a physical exam done by a health
care provider. Most (86%) Williams County women had a
clinical breast exam at some time in their life, and 46% had
one within the past year. More than half (52%) of women ages
40 and over had a clinical breast exam in the past two years.
 A Pap smear is a procedure to test for cervical cancer in women. Eighty-five percent (85%) of Williams County
women ages 21-65 had a Pap smear at some time in their life, and 32% reported having had the exam in the
past year. Nearly three-fifths (59%) of women had a Pap smear in the past three years. Ten percent (10%) of
women reported the screening was not recommended by their doctor.
 Women used the following as their usual source of services for female health concerns: Parkview (33%), Bryan
Community Health Center (13%), CHWC, (8%), CPC Women’s Health Resource (2%), Williams County Health
Department (Family Planning Clinic) (2%), a family planning clinic (1%), and some other place (29%). Eleven
percent (11%) indicated they did not have a usual source of services for female health concerns.
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Had a mammogram within the past
two years (women ages 40 and over)
69% 67% 65% 74%* 72%*
Had a pap test in the past three years
(women ages 21-65)
66% 54% 59% 82%* 80%*
Had a clinical breast exam in the
past two years (women ages 40 and
older)
68% 66% 52% N/A N/A
*2016 BRFSS
N/A – Not available
Williams County
Female Leading Causes of Death
2015–2017
Total Female Deaths: 641
1. Heart Diseases (22% of all deaths)
2. Cancers (20%)
3. Chronic Lower Respiratory Diseases (9%)
4. Alzheimer’s Disease (8%)
5. Stroke (5%)
(Source: Ohio Public Health Data Warehouse, 2015-2017)
Ohio
Female Leading Causes of Death
2015–2017
Total Female Deaths: 180,539
2. Cancers (20%)
4. Stroke (6%)
5. Alzheimer’s Disease (6%)

WOMEN’S HEALTH | 30

Women’s Health Concerns
Health Topic
2019 Williams
County Women
2018 Ohio Women 2017 U.S. Women
Obese 47% 34% 30%
High blood pressure 34% 33%* 31%
High blood cholesterol 32% 33%* 32%
Current smoker 19% 19% 14%
Diabetes 8% 13% 11%
Coronary heart disease 4% 4% 3%
Heart attack 3% 4% 3%
Stroke 3% 4% 3%
*2017 BRFSS
Pregnancy
 Nearly one-fourth (23%) of Williams County women had been pregnant in the past five years.
 During their last pregnancy, Williams County women:
— Took a multi-vitamin with folic acid (81%)
— Had a prenatal appointment in the first 3 months (77%)
— Had a dental exam (49%)
— Experienced depression (34%)
— Received WIC benefits (32%)
— Smoked cigarettes or used other tobacco products (11%)

MEN’S HEALTH | 31

Healthcare Access: Adult Men’s Health
Key Findings
Nearly half (45%) of men had high blood cholesterol,
45% had been diagnosed with high blood pressure, and
11% were identified as smokers, which, along with
obesity (38%), are known risk factors for cardiovascular
diseases.
Men’s Health Concerns
 Seven percent (7%) of men had survived a heart
attack at some time in their life.
 Five percent (5%) of men had survived a stroke at
some time in their life.
 One-in-ten (10%) men reported that a health
professional diagnosed them with coronary heart
disease.
 Major risk factors for cardiovascular disease include
obesity, high blood cholesterol, high blood pressure,
physical activity, and diabetes. (Source: CDC, Heart
Disease, 2019).
Men’s Health Concerns
Health Topic
2019 Williams
County Men
2018 Ohio Men 2017 U.S. Men
High blood cholesterol 45% 34%* 35%
High blood pressure 45% 37%* 35%
Obese 38% 34% 30%
Diabetes 16% 12% 11%
Current smoker 11% 22% 19%
Coronary heart disease % 6% 5%
Heart attack % 7% 5%
Stroke % 4% 3%
*2017 BRFSS
Williams County
Male Leading Causes of Death, 2015–2017
Total Male Deaths: 629
1. Cancers (26% of all deaths)
2. Heart Diseases (21%)
4. Accidents, Unintentional Injuries (6%)
5. Diabetes (4%)
Ohio
Male Leading Causes of Death, 2015–2017
Total Male Deaths: 180,695
2. Cancers (22%)
3. Accidents, Unintentional Injuries (8%)
5. Stroke (4%)

ORAL HEALTH | 32

Healthcare Access: Adult Oral Health
Key Findings
Nearly three-fourths (73%) of Williams County adults visited a dentist or dental clinic in the past year. Twenty-six
percent (26%) of adults who did not see a dentist in the past year were unable to do so due to cost.
Access to Dental Care
 In the past year, 73% of Williams County adults had visited a dentist or dental clinic, decreasing to 53% of those
with incomes less than $25,000.
 Three-fourths (75%) of Williams County adults with health insurance had been to the dentist in the past year,
compared to 48% of those without health insurance.
The following graph provides information about the frequency of Williams County adult dental visits. An
example of how to interpret the information includes: 73% of Williams County adults had been to the
dentist in the past year, including 75% of females and 53% of those with incomes less than $25,000.
Adult Oral Health
Within
the Past
Year
Within
the Past
2 Years
Within
the Past
5 Years
5 or
More
years
Never
Don’t
Know
Time Since Last Visit to Dentist/Dental Clinic
Males 69% 10% 6% 15% 0% 1%
Females 75% 7% 7% 9% 1% 1%
Total 73% 8% 6% 11% <1% 1%
73%
69%
75%
54%
76%
71%
53%
77%
0%
20%
40%
60%
80%
Williams
County 2019
Older
Income
<$25K
Income
$25K Plus
Williams County Adults Visiting a Dentist in the Past Year

ORAL HEALTH | 33

 Williams County adults who did not visit a dentist in the past year reported the following reasons for not doing
so:
— Cost (26%)
— Had no reason to go/had not thought of it (25%)
— Had dentures (13%)
— Fear, apprehension, nervousness, pain, and dislike going (6%)
— Could not get into a dentist (6%)
— Did not have/know a dentist (4%)
— Could not find a dentist who accepted Medicaid (3%)
— Dentist did not accept their medical coverage (2%)
— Multiple reasons (2%)
— Other reasons (14%)
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Visited a dentist or a dental clinic (within the
past year)
65% 53% 73% 68%* 66%*
Visited a dentist or a dental clinic (5 or more
years ago)
10% 15% 11% 11%* 10%*
*2016 BRFSS
3,096 Williams County adults last visited dentist
or dental clinic 5 or more years ago.

HEALTH STATUS PERCEPTIONS | 34
Health Behaviors: Adult Health Status Perceptions
Key Findings
Nearly half (47%) of Williams County adults rated their health status as excellent or very good. Conversely, about
one-in-eight (13%) adults described their health as fair or poor, increasing to 28% of those with incomes less than
$25,000.
General Health Status
 Nearly half (47%) of Williams County adults rated their health as excellent or very good. Williams County adults
with higher incomes (55%) were most likely to rate their health as excellent or very good, compared to 21% of
those with incomes less than $25,000.
 One in eight (13%) adults rated their health as fair or poor.
 Williams County adults were most likely to rate their health as fair or poor if they:
— Had been diagnosed with diabetes (32%)
— Had an annual household income under $25,000 (28%)
— Had high blood pressure (25%)
— Were 65 years of age or older (21%)
— Had high blood cholesterol (19%)
— Were divorced or widowed (15%)
 More than one-fourth (29%) of adults reported that poor mental or physical health kept them from doing usual
activities such as self-care, work, or recreation at least one day in the past month.
The following graph shows the percentage of Williams County adults who described their general health
status as excellent/very good, good, and fair/poor. An example of how to interpret the information
includes: 47% of Williams County adults, including 54% of those ages 30-64 and 55% of those with incomes
more than $25,000, rated their health as excellent or very good.
*Respondents were asked: “Would you say that in general your health is excellent, very good, good, fair or poor?
47% 50% 45%
33%
54%
37%
21%
55%
40% 37% 43% 67%
34%
42%
51%
35%
13% 13% 12%
0%
12%
21%
28%
10%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adult Health Perceptions*
Excellent/Very Good Good Fair/Poor

HEALTH STATUS PERCEPTIONS | 35
Physical Health Status
 One-fifth (20%) of Williams County adults rated their physical health as not good on four or more days in the
past month.
 Williams County adults reported their physical health as not good on an average of 3.5 days in the past month.
 Williams County adults were most likely to rate their physical health as not good (on four or more days during
the past month) if they:
— Were female (24%)
— Were over the age of 65 (24%)
Mental Health Status
 Thirty percent (30%) of Williams County adults rated their mental health as not good on four or more days in
the past month.
 Williams County adults reported their mental health as not good on an average of 4.4 days in the past month.
 Williams County adults were most likely to rate their mental health as not good (on four or more days during
the past month) if they:
— Were female (40%)
The following table shows the percentage of adults with poor physical and mental health in the past 30 days.
Health Status No Days 1-3 Days 4-5 Days 6-7 Days 8 or More Days
Physical Health Not Good in Past 30 Days*
Males 58% 18% 5% 2% 9%
Females 53% 17% 7% 2% 14%
Total 55% 18% 6% 2% 12%
Mental Health Not Good in Past 30 Days*
Males 58% 17% 6% 2% 10%
Females 40% 18% 9% <1% 29%
Total 49% 17% 7% 1% 20%
*Totals may not equal 100% as some respondents answered, “Don’t know/Not sure”.
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Rated general health as excellent or very good 56% 55% 47% 49% 51%
Rated general health as fair or poor 10% 14% 13% 19% 18%
Rated mental health as not good on four or more days (in
the past 30 days)
15% 23% 30% 26% 24%
Rated physical health as not good on four or more days (in
the past 30 days)
18% 20% 20% 23% 22%
Average number of days that physical health was not
good (in the past 30 days)
2.6 3.5 3.5 4.0* 3.7*
Average number of days that mental health was not good
(in the past 30 days)
2.3 4.5 4.4 4.3* 3.8*
Poor physical or mental health kept them from doing
usual activities, such as self-care, work, or recreation (on
at least one day during the past 30 days)
18% 17% 29% 24% 23%
*2016 BRFSS as compiled by 2019 County Health Rankings

WEIGHT STATUS | 36

Health Behaviors: Adult Weight Status
Key Findings
Almost three-quarters (73%) of Williams County adults were either overweight (31%), obese (20%), severely obese
(14%), or morbidly obese (8%) by Body Mass Index (BMI). More than half (57%) of adults engaged in some type of
physical activity or exercise for at least 30 minutes on 3 or more days per week.
Adult Weight Status
 Nearly three-fourths (73%) adults were either overweight (31%), obese (20%), severely obese (14%), or morbidly
obese (8%) by Body Mass Index (BMI), putting them at elevated risk for developing a variety of preventable
diseases.
 More than half (56%) of adults were trying to lose weight; 30% were trying to maintain their current weight or
keep from gaining weight; and 1% were trying to gain weight.
 Adults did the following to lose weight or keep from gaining weight:
 Ate less food, fewer calories, or foods low in fat (53%)
 Drank more water (49%)
 Exercised (49%)
 Ate a low-carb diet (20%)
 Used a weight loss program (5%)
 Took diet pills, powders or liquids without a doctor’s advice (4%)
 Smoked cigarettes (4%)
 Took prescribed medications (3%)
 Health coaching (3%)
 Went without eating 24 or more hours (2%)
 Had bariatric surgery (1%)
 Participated in a prescribed dietary or fitness program (1%)

Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Overweight (BMI of 25.0 – 29.9) 38% 30% 31% 34% 35%
Obese (includes severely and morbidly obese, BMI
of 30.0 and above)
30% 41% 42% 34% 32%

WEIGHT STATUS | 37

The following graph shows the percentage of Williams County adults who were overweight or obese by Body
Mass Index (BMI). An example of how to interpret the information includes: 26% of all Williams County
adults were classified as normal weight, 31% were overweight, and 42% were obese.
*Percentages may not equal 100% due to the exclusion of data for those who were classified as underweight
The following chart indicates the weight status of Williams County adults.
*Total rate of obesity is 42%.
26% 22%
29%
8%
26% 21% 19%
27%
31% 40% 23%
31%
27% 41%
29%
35%
42% 38%
47%
61%
46%
36%
50%
37%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income <
$25K
Income $25K
Plus
Williams County Adult BMI Classifications*
Obese, including Severely and Morbildy Obese (BMI of 30.0 and above)
Overweight (BMI of 25.0-29.9)
Normal (BMI of 18.5-24.9)
Underweight (BMI
below 18.5)
1%
Normal Weight (BMI
of 18.5 – 24.9)
26%
Overweight (BMI of
25.0 – 29.9)
31%
Class I Obese (BMI of
30.0-34.9)*
20%
Class II Obese
(Severely Obese,
BMI of 35.0-39.9)*
14%
Class III Obese
(Morbidly Obese,
BMI of 40.0+)*
8%

WEIGHT STATUS | 38

Physical Activity
 More than half (57%) of adults engaged in some type of physical activity or exercise for at least 30 minutes 3 or
more days per week; 31% of adults exercised 5 or more days per week; and 27% of adults were not
participating in any physical activity in the past week, including 3% who were unable to exercise.
 The CDC recommends that adults participate in moderate-intensity exercise for at least 2 hours and 30 minutes
every week, or vigorous-intensity exercise for at least 1 hour and 15 minutes every week. Whether participating
in moderate or vigorous exercise, CDC also recommends muscle-strengthening activities that work all major
muscle groups on 2 or more days per week (Source: CDC, Physical Activity Guidelines for Americans, 2nd edition, 2019).
 Williams County adults spent the most time doing the following physical activities in the past year: walking (42%),
running/jogging (8%), cycling (4%), exercise machines (3%), occupational exercise (3%), group exercise classes
(3%), exercise videos (2%), strength training (2%), swimming (1%), and other (4%). Twelve percent (12%) of adults
engaged in multiple types of exercise.
 Reasons for not exercising included the following:
 Time (24%)
 Too tired (24%)
 Weather (20%)
 Self-motivation or will power (19%)
 Laziness (15%)
 Pain or discomfort (12%)
 Did not like to exercise (11%)
 Chose not to exercise (8%)
 Could not afford a gym membership (7%)
 Ill or physically unable (6%)
 No exercise partner (5%)
 Poorly maintained/no sidewalks (5%)
 No childcare (4%)
 No walking, biking trails, or parks (3%)
 Did not know what activities to do (3%)
 Lack of opportunities for those with physical
impairments (3%)
 No gym available (2%)
 Afraid of injury (2%)
 Neighborhood safety (2%)
 Other reasons (3%)

 Adults reported the following would help them use community parks, bike trails, and walking paths more
frequently:
 More available parks, bike trails, and walking paths (30%)
 Improvements to existing parks, trails, and paths (21%)
 Better promotion and advertising of existing parks, trails, and paths (16%)
 Designated safe routes (15%)
 More public events and programs involving parks, trails, and paths (12%)
 Williams County adults had access to a wellness program through their employer or spouse’s employer with the
following features:
 Free/discounted gym membership (15%)
 Health risk assessment (11%)
 Gift cards or cash for participation in wellness program (10%)
 Lower insurance premiums for participation in wellness program (9%)
 On-site health screenings (8%)
 Free/discounted smoking cessation program (6%)
 Lower insurance premiums for positive changes in health status (6%)
 On-site fitness facility (5%)
 Healthier food options in vending machines or cafeteria (4%)
 Free/discounted weight loss program (4%)
 Gift cards or cash for positive changes in health status (2%)
 On-site health education classes (1%)
 Did not have access to any wellness programs (29%)
 Not employed (18%)
6,191 Williams County adults were severely or morbidly obese.

WEIGHT STATUS | 39

Nutrition
 The American Cancer Society recommends that adults eat at least 2 ½ cups of fruits and vegetables per day to
reduce the risk of cancer and to maintain good health.
 The table below indicates the number of servings of fruit and vegetables Williams County adults consumed
daily.
5 or more
servings
3-4
servings
1-2
servings
0
servings
Fruit 1% 13% 73% 13%
Vegetables 3% 21% 71% 5%
 The table below indicates the number of servings of sugar-sweetened beverages and caffeinated beverages
Williams County adults consumed daily.
5 or more
servings
3-4
servings
1-2
servings
0
servings
Sugar-sweetened beverages 5% 6% 39% 50%
Caffeinated beverages 10% 24% 48% 18%
 Williams County adults reported the following reasons they chose the types of food they ate:
 Taste/enjoyment (64%)
 Cost (53%)
 Healthiness of food (51%)
 Ease of preparation/time (38%)
 Availability (38%)
 What their family prefers (36%)
 Food they were used to (35%)
 Nutritional content (31%)
 Calorie content (25%)
 Artificial sweetener content (10%)
 If it is organic (8%)
 If it is genetically modified (7%)
 Health care provider’s advice (6%)
 Other food sensitivities (5%)
 Availability of food at the food pantry (4%)
 If it is lactose free (4%)
 Limitations due to dental issues (3%)
 If it is gluten free (3%)
 Limitations set by WIC (1%)
 Other reasons (3%)
 In a typical week, 59% of adults ate 1-to-2 meals out at a restaurant or brought home takeout food; 18% ate 3-
to-4 meals, and 7% ate 5 or more meals per week. Sixteen percent (16%) of adults reported they did not eat out
or bring takeout home to eat in a typical week.
 Williams County adults reported the following barriers in consuming fruits and vegetables: too expensive (21%),
did not like the taste (7%), did not know how to prepare them (4%), no variety (3%), no access (1%),
transportation (<1%), and other reasons (4%). Sixty-nine percent (69%) reported no barriers to consuming fruits
and vegetables.

TOBACCO USE | 40

Health Behaviors: Adult Tobacco Use
Key Findings
In 2019, 16% of Williams County adults were current cigarette smokers and 25% were considered former cigarette
smokers.
Adult Tobacco Use
 Sixteen percent (16%) of adults were current cigarette smokers (those who indicated smoking at least 100
cigarettes in their lifetime and currently smoked some or all days).
 In 2019, the American Cancer Society (ACS) stated that tobacco use remains the most preventable cause of
death worldwide. Despite decades of declines in cigarette smoking prevalence, almost 32% of cancer deaths in
the U.S. are still caused by smoking (Source: Cancer Facts & Figures, American Cancer Society, 2019).
 Adult smokers were more likely to have:
— Been a member of an unmarried couple (63%)
— Incomes less than $25,000 (30%)
— Rated their health status as fair or poor (28%)
 One-quarter (25%) of adults indicated that they were former cigarette smokers (smoked 100 cigarettes in their
lifetime and now do not smoke).
 Adults smokers reported using the following methods to quit cigarette smoking in the past year: cold turkey
(21%), e-cigarette or other electronic vaping products (8%), Chantix (7%), Wellbutrin (5%), nicotine patch (4%),
nicotine gum (4%), substitute behaviors (3%), quit line (1%), intervention (1%), and acupuncture (1%).
 Adults used the following tobacco products in the past year: cigarettes (17%); e-cigarettes/vaping products
(5%); chewing tobacco, snuff, snus (4%); cigars (3%); little cigars (1%); cigarillos (1%); pipes (1%); and dissolvable
tobacco (<1%). Six percent (6%) of adults used more than one tobacco product in the past year.
 Williams County adults had the following rules/practices about cigarette smoking in their home: never allowed
(70%), not allowed with children around (6%), allowed anywhere (6%), and allowed in certain rooms (2%).
 Williams County adults had the following rules/practices about cigarette smoking in their car: never allowed
(79%), allowed with windows open (7%), not allowed with children around (5%), and allowed anywhere (4%).
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Current cigarette smoker (smoked on some or all
days)
20% 22% 16% 21% 17%
Former cigarette smoker (smoked 100 cigarettes in
lifetime and now do not smoke)
24% 18% 25% 24% 25%
In 2019, 4,503 Williams County adults were current smokers.

TOBACCO USE | 41

The following graph shows the percentage of Williams County adults’ cigarettte smoking behaviors. An
example of how to interpret the information includes: 16% of all Williams County adults were current
cigarette smokers, 25% of all adults were former cigarette smokers, and 59% had never smoked.
Adult E-Cigarette Use
 Three-fifths (60%) of Williams County adults believed that e-cigarette vapor was harmful to themselves. Fifty-
eight percent (58%) of adults believed that e-cigarette vapor was harmful to others, and 3% did not believe it
was harmful to anyone. Thirty-two percent (32%) of adults did not know if e-cigarette vapor was harmful.
 Adults who have used e-cigarettes/vapes in the past year put the following in it: e-liquid or e-juice with
nicotine (17%), e-liquid or e-juice without nicotine (8%), and marijuana or THC in your e-liquid (1%).
Smoking and COPD
 The following graph shows Williams County, Ohio, and U.S. age-adjusted mortality rates per 100,000
populations for chronic lower respiratory diseases (formerly COPD). The graph indicates: from 2015-2017,
Williams County’s age-adjusted mortality rate for Chronic Lower Respiratory Disease was higher than the Ohio
and U.S. rates, but lower than the Healthy People 2020 target objective.
(Source: Ohio Public Health Data Warehouse, 2015-2017, CDC Wonder, 2015-2017 and Healthy People 2020)
*Healthy People 2020’s target rate is for adults aged 45 years and older.
16% 11%
19% 25%
17%
9%
30%
13%
25% 35% 18%
8% 24% 40%
28%
28%
59% 54%
63% 67%
59%
51%
42%
59%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adult Cigarette Smoking Behaviors
Current smoker Former smoker Never smoked
62
49
41
103
0
20
40
60
80
100
120
Rateper100,000population
Age-Adjusted Mortality Rates for
Chronic Lower Respiratory Diseases (Formerly COPD)
Williams County 2015-2017 Ohio 2015-2017 U.S. 2015-2017 HP 2020 Target*

ALCOHOL CONSUMPTION | 42

Health Behaviors: Adult Alcohol Consumption
Key Findings
More than three-fifths (62%) of Williams County adults had at least one alcoholic drink in the past month and are
considered current drinkers. One-third (33%) of those current drinkers were binge drinkers [had five or more
alcoholic drinks (for males) or 4 or more drinks (for females) on an occasion in the last month].
Adult Alcohol Consumption
 More than three-fifths (62%) of adults had at least one alcoholic drink in the past month, increasing to 68% of
those ages 30-64.
 Of current drinkers, adults drank 3.2 drinks on average on the days that they drank, increasing to 4.0 drinks for
males and 5.0 drinks for those with incomes less than $25,000.
 One-in-six (17%) Williams County adults reported they had five or more alcoholic drinks (for males) or 4 or
more drinks (for females) on an occasion in the last month and would be considered binge drinkers. Among
current drinkers, 33% were considered binge drinkers.
 Williams County adults indicated they or a family member experienced the following in the past 6 months:
 Drove after having any alcoholic beverage (10%)
 Drank more than they expected (7%)
 Used prescription drugs while drinking (5%)
 Continued to drink despite problems caused by drinking (3%)
 Gave up other activities to drink (3%)
 Failed to fulfill duties at work, home, or school (3%)
 Spent a lot of time drinking (2%)
 Tried to quit or cut down but could not (2%)
 Had legal problems (1%)
 Drank more to get the same effect (1%)
 Lost employment (<1%)
 Experienced financial hardship (<1%)
 Drank to ease withdrawal symptoms (<1%)
 One percent (1%) of Williams County adults used a program to help with an alcohol problem for themselves or
a loved one. Reasons for not using such a program included the following: had not thought of it (9%), could not
afford to go (1%), stigma of seeking drug services (1%), limited capacity (<1%), and other reasons (6%). Eighty-
four percent (84%) of adults indicated such a program was not needed.
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Current drinker (had at least one drink of alcohol within
the past 30 days)
45% 39% 62% 54% 55%
Binge drinker (males having five or more drinks on one
occasion, females having four or more drinks on one
occasion)
18% 15% 17% 19% 17%
4,784 Williams County adults were binge drinkers.

ALCOHOL CONSUMPTION | 43

The following graphs show the percentage of Williams County adults consuming alcohol and the amount
consumed on average. An example of how to interpret the information shown on the first graph includes:
38% of all Williams County adults did not drink alcohol, including 35% of males and 41% of females.
*Percentages may not equal 100% as some respondents answered, “don’t know”
The following graph shows the the average number of drinks consumed per drinking occasion. An example
of how to interpret the information shown on the first graph includes: Williams County adults drank an
average of 3.2 drinks per drinking occasion, increasing to 4.0 drinks for males and 5.0 drinks for those with
incomes less than $25,000.
Note for graphs: Caution should be used when interpreting subgroup results as the margin of error for any subgroup is higher than that of the
overall survey.
38% 35% 41%
54%
32%
49% 46%
35%
22%
16%
26%
8%
22%
26% 29%
20%
40%
49%
33% 38%
46%
25% 24%
45%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Average Number of Days Drinking Alcohol in the Past Month
Did not drink any 1-2 days 3 or more days
3.2
4.0
2.5
4.6
2.9
3.3
5.0
3.6
0
1
2
3
4
5
6
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Adult Average Number of Drinks Consumed Per Drinking Occasion

DRUG USE | 44

Alcohol-Impaired Driving Deaths
Alcohol-Impaired Driving Deaths is the percentage of motor vehicle crash deaths with alcohol involvement.
Approximately 17,000 Americans are killed annually in alcohol-related motor vehicle crashes. Binge/heavy drinkers
account for most episodes of alcohol-impaired driving.
 The alcohol-impaired driving deaths in Williams County is 37%.
 The alcohol-impaired driving deaths in Ohio is 34%.

(Source: Fatality Analysis Reporting System, as compiled by County Health Rankings, 2017)

DRUG USE | 45

Health Behaviors: Adult Drug Use
Key Findings
Three percent (3%) of Williams County adults had used recreational marijuana during the past 6 months. Five
percent (5%) of adults had used medication not prescribed for them or took more than prescribed to feel good or
high and/or more active or alert during the past 6 months.
Marijuana and Other Drug Use
 Three percent (3%) of adults had used marijuana or hashish for recreational purposes in the past 6 months.
 Five percent (5%) of Williams County adults plan on obtaining medical marijuana when it becomes available.
 Adults reported that they, an immediate family member, or someone in their household used the following in
the past 6 months: synthetic marijuana/K2 (13%); wax, oil with THC edibles (5%); inappropriate use of over-the-
counter medications (4%); amphetamines, methamphetamines, or speed (3%); heroin/fentanyl (3%); cocaine,
crack, or coca leaves (3%); inhalants (2%); ecstasy or GHB (2%); LSD, mescaline, peyote, psilocybin, DMT,
mushrooms (2%); and bath salts (2%).
 As a result of using drugs, Williams County adults indicated they or a family member: experienced financial
hardship (3%), failed a drug screen (2%), placed themselves in dangerous situations (2%), regularly failed to
fulfill obligations at work or home (1%), lost or were denied employment because of a failed drug screen (1%),
had legal problems (1%), and received Narcan or nasal Naloxone (<1%).
The following graph indicates adult recreational marijuana use in the past 6 months. An example of how to
interpret the information includes: 3% of Williams County adults used recreational marijuana in the past 6
months, including 4% of males and 5% of those with incomes less than $25,000.

3%
4%
2%
0%
5%
1%
5%
2%
0%
1%
2%
3%
4%
5%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adult Recreational Marijuana Use in Past 6 Months
In 2019, 844 Williams County adults used marijuana or hashish for
recreational purposes in the past 6 months.

DRUG USE | 46

Prescription Drug Misuse
 In the past 6 months, 5% of adults had used drugs not prescribed for them or took more than prescribed to
feel good, high, and/or more active or alert.
 Adults reported that they, an immediate family member, or someone in their household took the following
medications not prescribed to them to feel good, high, and/or more active or alert during the past 6 months:
 Steroids (4%)
 Tranquilizers such as Valium or Xanax (3%)
 Tramadol/Ultram (3%)
 Vicodin (3%)
 Ritalin, Adderall, Concerta, or other ADHD
medication (2%)
 Codeine, Demerol, Morphine, Percocet,
Dilaudid, or Fentanyl (2%)
 OxyContin (2%)
 Neurontin (1%)
 Suboxone or methadone (1%)
 One percent (1%) of adults reported they have been prescribed opioid based medications and have had trouble
stopping.
 Adults indicated they did the following with their unused prescription medication:
 Did not have any unused medication (37%)
 Took as prescribed (25%)
 Threw them in the trash (16%)
 Kept them (15%)
 Flushed them down the toilet (15%)
 Took them to a medication collection
program (12%)
 Took them to local law enforcement (7%)
 Took them to Drug Take Back Days (5%)
 Kept them in a locked cabinet (3%)
 Gave them away (1%)
 Used drug deactivation pouches (1%)
 Other (2%)
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Adults who used recreational marijuana or hashish
in the past 6 months
3% 4% 3% N/A N/A
Adults who misused prescription drugs in the past
6 months
6% 5% 5% N/A N/A
In 2019, 1,407 Williams County adults used drugs not prescribed for them or
took more than prescribed to feel good, high, and/or more active or alert.

DRUG USE | 47

The following graphs indicates adult medication misuse in the past 6 months. An example of how to
interpret the information includes: 5% of Williams County adults misused prescription drugs in the past 6
months, including 7% of females and 5% of those with incomes more than $25,000.

Treatment Programs and Services
 One percent (1%) of Williams County adults had used a program or service to help with an alcohol or drug
problem for themselves or a loved one. Reasons for not using a program or service to help with a drug or
alcohol problem included: had not thought of it (1%), could not afford to go (<1%), insurance did not
cover it (<1%), and other reasons (1%). Ninety-eight percent (98%) of adults indicated this type of
program was not needed.

5%
2%
7%
10%
5%
3%
0%
5%
0%
5%
10%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Williams County Adult Prescription Drug Misuse in Past 6 Months

DRUG USE | 48

Opiate and Pain Reliever Doses
The following graphs are data from the Ohio Automated Prescription Reporting System (OARRS) indicating
Williams County and Ohio opiate and pain reliever doses per patient, as well as doses per capita.

(Source: Ohio Automated Rx Reporting System, Quarterly County Data, 2012-2018)
213.3
237.6 232.4
219.2
200.0 197.4
174.8
250.4
279.5 273.7
265.7 265.0 254.0
244.4
0
100
200
300
2012 2013 2014 2015 2016 2017 2018
DosesperPatient
Williams County and Ohio
Number of Opiate and Pain Reliever Doses Per Patient
2012-2018
Williams County Ohio
52.9 53.9 53.3
46.1
38.1
34.5
27.2
68.7 67.4 65.1
60.8
55.1
49.3
40.5
0
20
40
60
80
2012 2013 2014 2015 2016 2017 2018
DosesperCapita
Number of Opiate and Pain Reliever Doses Per Capita
2012-2018

DRUG USE | 49

Opioid Doses
The following graphs are data from the Ohio Automated Prescription Reporting System (OARRS) indicating
Williams County and Ohio opioid doses per capita, as well as doses per patient.
(Source: Ohio’s Automated Rx Reporting System, 2018-2019)
6.9 6.8 6.6 6.8 6.6
10.33 10.01 10.03 9.98 9.59
0
6
12
2018 Quarter 1 2018 Quarter 2 2018 Quarter 3 2018 Quarter 4 2019 Quarter 1
Rateper100,000Population
Number of Opioid Doses Per Capita,
Quarterly from 2018-2019
109.0
106.0
109.0 108.4 106.5
136.8 135.5 137.2
134.7 134.5
90
105
120
135
150
2018 Quarter 1 2018 Quarter 2 2018 Quarter 3 2018 Quarter 4 2019 Quarter 1
Number of Opioid Doses Per Patient
Quarterly from 2018-2019

DRUG USE | 50

Unintentional Drug Overdose Deaths
The table below shows the number of unintentional drug overdose deaths, and average crude and age-adjusted annual death rates per 100,000 population, for
Williams County and Ohio.
Number of Unintentional Drug Overdose Deaths and Average Crude
and Age-Adjusted Annual Death Rates Per 100,000 Population, by County, 2005-2017
(Source: Ohio Department of Health., 2017 Ohio Drug Overdose Data: General Findings)
2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
2012-2017
Total
Crude
Rate
Age
Adjusted
Rate
Williams
County
1 1 1 2 2 3 1 1 5 2 1 9 4 22 9.9 11.4
Ohio 1,020 1,261 1,351 1,473 1,423 1,544 1,772 1,914 2,110 2,531 3,050 4,050 4,854 18,509 26.6 27.9

DRUG USE | 51

Age-Adjusted Unintentional Drug Overdose Death Rates for Ohio
The following map illustrates the average age-adjusted unintentional drug overdose death rate per 100,000
population, by county from 2012-2017.
(Source: Ohio Department of Health, 2017 Ohio Drug Overdose Data: General Findings)

DRUG USE | 52

Unintentional Drug Overdose Death Rates by Age and Gender
The following graphs show the average age-adjusted unintentional drug overdose death rate per 100,000
population by age and gender from 2012-2017.

(Source for graphs: ODH, Ohio Public Health Data Warehouse, Mortality, Unintentional Drug Overdose Data, Unintentional Drug Overdose
Resident Deaths per 100,000 Population by County, updated 7/8/2019)
14.9
27.6
22.7
9.8
6.2
0.0
0
10
20
30
15-24 25-34 35-44 45-54 55-64 65+
2012-2017 Williams County
Unintentional Drug Overdose Mortality Rates by Age
16.0
N/A
0
10
20
Male Female
2012-2017 Williams County
Age-Adjusted Unintentional Drug Overdose Mortality Rates by Gender

DRUG USE | 53

Felony Cases and Drug Arrests January – June 2018
 Ohio State Highway Patrol (OSHP) investigated a wide range of felony offenses in 2018 including
homicide/death (45); robbery/burglary (7); larceny (686); assault (2,170); false pretense (185); vice (4,768);
property crimes (153); and various other types of felony offenses (307).
 OSHP Troopers made 16,956 total drug arrests in 2018 - a 2% increase from 2017 and a 20% rise over the
previous 3-year average (2015-2017). Total drug arrests in 2018 were 76% higher than they were in 2013.
(Source: Ohio State Highway Patrol, Felony Cases and Drug Arrests, January – June 2018)

SEXUAL BEHAVIOR | 54

Health Behaviors: Adult Sexual Behavior
Key Findings
In 2019, 65% of Williams County adults had sexual intercourse in the past year. Three percent (3%) of adults had
more than one partner. Ten percent (10%) of Williams County adults reported being forced to participate in sexual
activity when they did not want to.
Adult Sexual Behavior
 Sixty-five percent (65%) of Williams County adults had sexual intercourse in the past year. Three percent (3%) of
adults reported they had intercourse with more than one partner in the past year.
 Adults used the following methods of birth control:
 No partner/not sexually active (25%)
 They or their partner were too old (18%)
 Vasectomy (17%)
 Tubes tied (15%)
 Hysterectomy (9%)
 Condoms (7%)
 Birth control pill (7%)
 Infertility (3%)
 IUD (3%)
 Withdrawal (3%)
 Having sex only at certain times (3%)
 Contraceptive ring (2%)
 Ovaries or testicles removed (2%)
 Shots (1%)
 Contraceptive implants (1%)
 Practicing abstinence (1%)
 Emergency contraception (<1%)
 Seven percent (7%) of adults were not using any method of birth control and 5% were trying to get pregnant.
 The following situations applied to Williams County adults in the past year:
 Had sex without a condom (28%)
 Had anal sex without a condom (7%)
 Had sex with someone they met on social
media (3%)
 Had sexual activity with someone of the
same gender (3%)
 Had sex with someone they did not
know (2%)
 Were forced to have sex (2%)
 Had 4 or more partners in the past year (1%)
 Treated for an STD (1%)
 Engaged in sexual activity they would not
have done sober (1%)
 Tested positive for HIV (<1%)
 One-in-ten (10%) Williams County adults were forced or coerced to have any sexual activity when they did not
want to, increasing to 15% of females. Ten percent (10%) of those who were forced to have sexual activity
reported it.
 Reasons for not reporting their sexual assault included: they were scared (44%), they were in a relationship with
the offender (29%), they did not know how (12%), the stigma (9%), they feared the offender (3%), and other
reasons (18%).
N/A – Not available
Adult Comparisons
Williams
County
2013
Williams
County
2016
Williams
County
2019
Ohio
2017
U.S.
2017
Had more than one sexual partner in past year 3% 4% 3% N/A N/A
844 Williams County adults had intercourse with more than
one partner in the past year.


The following graph shows the number of sexual partners that Williams County adults had in the past year.
An example of how to interpret the information in the graph includes: 62% of all Williams County adults
had one sexual partner in the past year, 3% had more than one partner, and 34% did not have a sexual
partner.
Respondents were asked: “During the past 12 months, with how many different people have you had sexual intercourse?”
62% 64% 60%
83%
67%
28% 29%
67%
3% 3%
4%
8%
3%
0% 2%
2%
34% 32% 36%
8%
29%
71%
66%
31%
0%
20%
40%
60%
80%
100%
Williams
County 2019
Older
Income
<$25K
Income $25K
Plus
Number of Sexual Partners in the Past Year
One More than one None


Chlamydia
The following graphs show Williams County chlamydia disease rates per 100,000 population. The graphs show:
 Williams County chlamydia rates increased from 2014 to 2018.
 The number of chlamydia cases in Williams County increased from 2014-2018.
(Source: Ohio Department of Health, STD Surveillance Program, Data reported through 5/2/2019)
174.6
242.5
375.5
388.8
418.7
468.4
489.9
521.8 526.8 543.4
0
100
200
300
400
500
600
2014 2015 2016 2017 2018
Chlamydia Annualized Disease Rates for Williams County and Ohio
65
90
139 143
154
20
40
60
80
100
120
140
160
180
2014 2015 2016 2017 2018
Numberofcasesreported
Annualized Count of Chlamydia Cases for Williams County


Gonorrhea
The following graphs show Williams County gonorrhea disease rates per 100,000 population. The graphs show:
 The Williams County gonorrhea rate fluctuated from 2014-2016, then increased from 2016-2018.
 The Williams Country gonorrhea cases fluctuated from 2014 to 2016, then increased from 2016-2018.

(Source for graphs: Ohio Department of Health, STD Surveillance Program, Data Reported through 5/2/19)

13.4 18.9 16.2
38.1
62.5
138.4 143.1
176.8
205.8
216.3
0
50
100
150
200
250
2014 2015 2016 2017 2018
Gonorrhea Annualized Disease Rates for Williams County and Ohio
5
7
6
14
23
0
5
10
15
20
25
2014 2015 2016 2017 2018
Numberofcasesreported
Annualized Count of Gonorrhea Cases for Williams County
Williams County


Birth Data
Please note that the pregnancy outcomes data includes all births to adults and adolescents.

(Source: ODH Information Warehouse, updated 7/14/19)
416
431 438
402 408
0
250
500
2014 2015 2016 2017 2018
NumberofLiveBirths
Williams County Total Live Births
138
633
685
438
177
20
0
350
700
15-19 20-24 25-29 30-34 35-39 40-44
NumberofLiveBirths
Williams County Live Births by Age of Mother, 2014-2018


Pre-Term Births
 Please note that birth data includes all births to adolescents and adults. Data available from Ohio Department
of Health is for birth count only.
The following graphs show Williams County pre-term deliveries among live births by year as well as by age
of mother.

(Source for graphs: ODH Information Warehouse, 2019)
7%
7%
8%
10%
7%
0%
5%
10%
2014 2015 2016 2017 2018
PercentofPre-TerrmDeliveriesAmong
LiveBirths
Pre-Term Deliveries Among Williams County Resident Live Births by Year
13%
9%
8%
6%
7%
0%
0%
5%
10%
15%
15-19 20-24 25-29 30-34 35-39 40-44
PercentofPre-TerrmDeliveriesAmong
LiveBirths
Pre-Term Deliveries Among Williams County Resident Live Births
by Age of Mother, 2014-2018


Low Birth Weight
 Please note that birth data includes all births to adolescents and adults. Data available from Ohio Department
of Health is for birth count only.
The following graph shows the Williams County distribution of low birth weights among live births by year
and age of mother.

(Source for graphs: ODH Information Warehouse, 2019)
5%
5%
7%
6%
4%
0%
5%
10%
2014 2015 2016 2017 2018
Distribution(Percent)ofLowBirth
WeightsAmongLiveBirths
Williams County
Distribution of Low Birth Weights Among Live Births by Year
13%
6% 6%
4%
5% 5%
0%
5%
10%
15%
20%
15-19 20-24 25-29 30-34 35-39 40-44
Distribution(Percent)ofLowBirth
WeightsAmongLiveBirths
Williams County
Distribution of Low Birth Weights Among Live Births
by Age of Mother, 2014-2018

Examining The Health of Williams County

Examining The Health of Williams County

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